Emergency care visits at a South African hospital: Implications for healthcare services and policy.

BACKGROUND:  A robust knowledge on the pattern of use of emergency care resources not only serves as an indicator of universal access to care but also provides a basis for quality improvement within the health system. This study was undertaken to describe the pattern of emergency room visits at Brits District Hospital (BDH) in North West province, South Africa. The objectives of this study were to determine the sociodemographic characteristics of emergency department (ED) users and other patterns of ED use. METHODS:  This was a cross-sectional descriptive study that was conducted at a district hospital. All patients who reported for emergency care in the ED in 2016 were eligible for the study. Data were extracted and analysed from a systematic sample of 355 clinical notes and hospital administrative records. RESULTS:  The age group that visited the ED most frequently (25.3%) was 25-34 years old. A high proportion of the ED users (60%) were self-referred, and only 38% were transported by the emergency medical response services (EMRS). Few (5.6%) presentations were of a non-urgent nature. Trauma-related conditions accounted for the most frequent presentation at the ED (36.5%). CONCLUSION:  Although most ED users were self-referred, their clinical presentations were appropriate and underscore the need for policy strategies to reduce the burden of trauma in the catchment populationContribution: The study findings may have an impact on future health policies by providing decision-makers with baseline information on the pattern of use of ED resources, ensuring better resource deployment and greater access to care.

Umbilical vein catheterisation for the family physician working in primary health care.

This is part of a series of articles on vascular access in emergencies. The other two articles were on intra osseous lines and central venous lines. These are critical lifesaving emergency skills for the primary care professional. In this article, we will provide an overview of umbilical vein catheterisation highlighting its importance, the indications, contraindications, techniques, complications and nursing considerations. By familiarising healthcare providers with this procedure, we hope to enhance their knowledge and skills, ultimately leading to improved outcomes in the neonatal population.

Central venous pressure line insertion for the primary health care physician.

Central venous access is an important procedure to understand and perform not only in the emergency unit but also for prolonged reliable venous access. All clinicians must be familiar and confident with this procedure. This paper will focus on applied anatomy in respect of common anatomical sites for venous access, the indications, the contraindications, the technique and complications that may arise following the procedure. This article is part of a series on vascular access. We have previously written on the intra osseous procedure and an article on umbilical vein catheterisation will follow.

Intraosseous line insertion for the primary health care physician.

Early rapid access to the vascular system is essential in emergencies and is lifesaving. In this article, we will provide information on the common sites used, the equipment that is required, the indications and contraindications for intraosseous line insertion, how to correctly and safely do the procedure, medication that can be administered, post insertion line management and possible complications. This is a lifesaving procedure and primary healthcare physicians should acquire this skill.

Reasons given by women for discontinuing the use of progestogen implants at Koster Hospital, North West province.

BACKGROUND: In 2014, the South African National Department of Health introduced a new addition to the long-acting reversible contraceptive (LARC) options available in the country. This was a single rod subdermal progestogen implant (Implanon®NXT) which provided 3 years of effective contraception cover. However, the new contraceptive device uptake and general acceptance amongst women quickly diminished, with a slew of requests for its removal. The aim of this study was to explore the reasons given by women for discontinuing the use of their progestogen implants at Koster Hospital, North West province, South Africa. METHODS: A qualitative study was conducted using semistructured interviews. Thirteen women were purposively selected and interviewed at Koster Hospital Family Planning Unit. The transcriptions of the audio-taped interviews were analysed thematically. RESULTS: The following themes emerged from the interviews as reasons the women discontinued their progestogen implants: side effects such as menstrual problems, arm discomfort and weight gain. Other themes were family or social factors and the desire to conceive. CONCLUSION: The reasons for discontinuation of Implanon by women at Koster Hospital were the undesirable side effects they experienced whilst using the contraceptive device. These side effects were mainly menstrual problems, arm discomfort and weight gain. Family and other social dynamics also influenced some of the participants' decision to discontinue their contraceptive implants.

Effects of antibiotic treatment on microbiota, viral transmission and viral pathogenesis of MoMuLV ts1 infected BALB/c mice.

The effects of normal and altered intestinal microbiota on murine retroviral transmission via the gastrointestinal tract (GIT) are diverse. The role of orally administered antibiotic treatment (ABX) on viral transmission, GIT microbial dysbiosis and subsequent pathogenesis of Moloney Murine Leukemia virus-temperature sensitive 1 (ts1) on BALB/c mice were studied. BALB/c mice were divided into four groups: ABXts1-Treatment/Infection;ABX-Treatment/No infection;ts1-No treatment/Infection;Ctrl (control)-No treatment/No infection. ABXts1 and ABX groups showed a significant phylogenetic shift (ANOSIM p-value = 0.001) in alpha and beta diversity comparisons for microbial community composition compared to Ctrl group. Mice in the ABXts1 and ABX groups showed megacolon compared to ts1 and Ctrl groups; ABXts1 and ts1 groups showed hepatosplenomegaly, thymus enlargement, and mesenteric lymphadenopathy compared to ABX and Ctrl groups. Ctrl group had no abnormal manifestations. ABX treatment and ts1 infection uniquely affect microbial community when compared to control: ABXts1 and ABX groups significantly reduce microbiome diversity by over 80% and ts1 group by over 30%. ABXts1 and ts1 groups' viral load and clinical manifestations of infection were comparable; antibiotic treatment did not notably affect ts1 infection. Transmission and pathophysiology of ts1 infection were not significantly altered by the microbial composition of the GI tract, but ts1 viral infection did result in microbial dysbiosis independent of antibiotic treatment.

Knowledge, attitude and practice regarding lifestyle modification in type 2 diabetic patients.

BACKGROUND: The number of persons suffering from type 2 diabetes mellitus continues to rise worldwide and causes significant morbidity and mortality, especially in the developing world. Behaviour change and adoption of healthy lifestyle habits help to prevent or slow down the complications of type 2 diabetes mellitus. However, the knowledge and practice of healthy lifestyles in many diabetic patients have been inadequate. AIM: This study sought to establish the knowledge, attitude and practice regarding lifestyle modification amongst type 2 diabetic patients. SETTING: The diabetic clinic of Mamelodi hospital, Pretoria, Gauteng Province, South Africa. METHODS: A cross-sectional study was done using a structured questionnaire amongst 217 type 2 diabetic patients seen at the diabetic clinic of Mamelodi hospital. Baseline characteristics of the participants were obtained and their knowledge, attitude and practice regarding lifestyle modification were assessed. RESULTS: Of the 217 participants, 154 (71%) were obese and 15 (7%) were morbidly obese. The majority of respondents (92.2%) had poor knowledge of the benefits of exercise, weight loss and a healthy diet. What is interesting is that the majority (97.7%) demonstrated bad practices in relation to lifestyle modifications, although over four-fifths (84.3%) had a positive attitude toward healthy lifestyle modifications. CONCLUSION: Despite the positive attitudes of respondents toward healthy lifestyle modifications, the knowledge and practice regarding lifestyle modifications amongst type 2 diabetes mellitus participants seen at Mamelodi hospital were generally poor.

Retrovirus-induced lymphomagenesis: a correlation between disease pathogenesis and flow cytometric analysis.

Perinatal infection with a temperature-sensitive mutant (ts-1) of Moloney murine leukemia virus (MoMuLV) results in massive splenomegaly and thymomegaly in mice and development of lymphoma in >55 % of infected pups. Previous flow cytometry studies showed a decrease in CD4(+) cells in perinatally infected pups, but cell population changes in infected animals with lymphoma compared with infected animals without lymphoma has not yet been reported. In the current study, BALB/c mice were infected with ts-1 through breast milk transmission and observed until development of clinical signs and symptoms of lymphoma and/or symptomatic ts-1 infection. Flow cytometry studies were performed on blood, spleen and thymus samples and correlated with gross morphology and histological changes, resulting from the development of lymphoma. Infected animals with lymphoma had significant decreases in CD4(+) and CD8(+) cell counts in blood and spleen compared with controls. The spleens of infected animals without lymphoma showed a decrease in CD4(+) and CD8(+) cell counts, but this was not significant compared with controls. In the thymus, CD4(+) and CD8(+) cell counts also decreased, but this was not significant in infected animals with and without lymphoma compared with controls. Markers of myeloid cell dysfunction increased in the thymus of animals with infection with and without lymphoma compared with controls. Thus, immunosuppression and CD4(+)/CD8(+) cell decreases in the spleen and thymus are associated with malignant transformation and development of lymphoma in this animal model.

The Experience and Psychosocial Needs of Patients with Traumatic Fractures Treated for More than Six Months at Doctors on Call for Service Hospital; Goma; Democratic Republic of Congo

Trauma-related consultations; admissions and complications are the leading problems at Doctors on Call for Service (DOCS) Hospital; Goma; Democratic Republic of Congo; and yet no studies have been carried out to document the experience of long-stay traumatic-fracture patients in this hospital. Aim: The aim of this study was to explore the experience and psychosocial needs of patients with traumatic fractures treated for more than six months at DOCS Hospital. Methods: Six free-attitude interviews were conducted with purposively selected patients. The interviews were recorded with a tape recorder and transcribed verbatim; and content analysis was used to identify themes from the interviews. Results: All patients could clearly connect the injury experience to severe pain that lingered on for weeks or months for some patients; accompanied by other symptoms such as insomnia; poor appetite and psychological symptoms. Most patients felt disabled; were abandoned by relatives or friends and experienced financial problems. Some benefited from the injury by way of strengthened marital links. Some patients complained of poor information about their illness and the management plan and did not appreciate the treatment from caregivers; while some disclosed their needs and expectations and appreciated the caregivers who showed interest in them. Conclusions: The experience of long-term trauma has negative effects on the whole person of the patient; including his or her work and family; and some patients continue to suffer from the effects of the traumatic event up to six months later. The needs of patients suffering from trauma include reassurance by physicians and nurses; more information and participation in the decision-making process; regular visits from friends and family; and better bedside manners from caregivers

Retroviral gene insertion in breast milk mediated lymphomagenesis.

We have demonstrated breast milk transmitted MoMuLV-ts1 retrovirus infection and subsequent lymphoma development in offspring of uninfected mothers suckled by infected surrogate mothers. Additionally, we have shown that the lymphoma development occurs as a result of viral gene integration into host genome. A total of 146 pups from Balb/C mice were divided into 5 groups; one control and 4 experimental. All offspring suckled from surrogate infected or control mothers, except one group of infected pups left with their biological mothers. Thirteen of 91 infected pups developed lymphoma. Inverse-PCR, DNA cloning, and quantitative real-time PCR (qRT-PCR) were used to study the virus integration sites (VIS) and alterations in gene expression. VIS were randomly distributed throughout the genome. The majority of insertion sites were found in chromosomes 10, 12 and 13. A total of 209 proviral genomic insertion sites were located with 52 intragenic and 157 intergenic sites. We have identified 29 target genes. Four genes including Tacc3, Aurka, Gfi1 and Ahi1 showed the maximum upregulation of mRNA expression. These four genes can be considered as candidate genes based on their association with cancer. Upregulation of these genes may be involved in this type of lymphoma development. This model provides an important opportunity to gain insight into the relationship of viral gene insertion into host genome and development of lymphoma via natural transmission route such as breast milk.

Transmission of Moloney murine leukemia virus (ts-1) by breast milk.

A murine model has been developed to study maternal transmission of the temperature-sensitive Moloney murine leukemia virus (ts-1). The goal of this study was to confirm early and late mother-to-offspring transmission of the virus and demonstrate transmission via breast milk. A series of six experiments was performed using six groups of BALB/c mice. Group 1 consisted of pups born to ts-1-infected mothers removed at birth to suckle from surrogate uninfected mothers. Groups 2 and 5 consisted of pups born to ts-1-infected mothers that suckled from ts-1-infected mothers (surrogate and biological). Group 3 consisted of non-infected pups removed at birth to suckle from ts-1-infected mothers. Groups 4 and 6 consisted of non-infected pups suckled from non-infected mothers. The combined in utero, intrapartum and breast-milk infection rate was 100 % to the offspring (groups 2 and 5). The in utero to early post-partum group (group 1) had an infection rate of 78 %. Breast milk alone (group 3) resulted in a 97 % infection rate. Control groups (groups 4 and 6) had a 0 % infection rate. The relative frequency of maternal CD4(+) cells in peripheral blood mononuclear cells was consistently lower in infected mothers, whilst offspring did not show a significant decrease in CD4(+) frequency. Pups infected via breast milk had a lower CD4(+) frequency (group 3) than those infected by the uterine and/or intrapartum route (group 1). Breast milk from ts-1-infected mothers appears to be highly infectious for neonatal BALB/c mice.

Vertical transmission of a murine retrovirus, ts1.

Mechanism of maternal retroviral transmission remains an unsolved problem. The current investigation is a part of our ongoing research on vertical transmission of MoMuLV-TB ts1 in BALB/c mice. A total of 270 adult mice and 165 fetuses were used. Forty-four experimental mice were injected with 0.1 mL of 4.0 x 10(6) ffu/mL of ts1 virus at 72 h after birth; 24 controls were injected with DMEM. Almost half of the females went through two rounds of pregnancies. In the first round, 135 experimental and 57 control pups were produced. Forty-three experimental and 20 control pups were followed until they developed clinical symptoms. The second round of pregnancy produced a total of 46 mid-gestational and 119 full-term fetuses. PCR, and light and electron microscopy were performed to evaluate viral transmission. Overall, 99% vertical transmission occurred in pups of infected mothers. Twelve percent of mid-gestational and 39% full-term fetuses were PCR positive. We have established that, if mothers are infected with ts1 virus at 72 h after birth, then nearly 100% vertical transmission occurs, via in utero, intrapartum, or breast milk. Thirty-nine percent transmission occurred in utero alone. This is an excellent model to study the transplacental and post-gestational transmission of retroviruses, such as ts1.

A small animal model for mother-to-fetus transmission of ts1, a murine retrovirus.

Infection with a murine retrovirus, MoMuLV-TB, ts1 in BALB/c mice has been established as a small animal model for retroviral neurodegenerative disease as shown with infections such as HIV. However, mother-to-pup transmission has never been demonstrated in this model. The current investigation examines vertical transmission of ts1 in this mouse model. A total of 15 females were used to produce 59 pups (16 were used for control, and 43 were used as experimental animals). For experiment 1, 24 5-day-old mice were injected with [0.2 mL of 2.0 x 10(6) ffu/mL ts1] virus. For experiment 2, 19 48-h-old mice were injected with [0.1 mL of 4 x 10(6) ffu/mL ts1] virus. Control groups were injected with DMEM only. PCR and electron microscopy were performed to determine the presence of virus. All mice from experiment 1 injected with ts1 showed viral infection, and retained 100% reproductive capacity. Three out of 102 pups produced by these infected females were infected with ts1. Nine percent of the pups from experiment 2 injected with ts1 retained normal reproductive capacity, and two out of eight (25%) pups had viral infection. Vertical transmission of this unique retrovirus occurs and is dependent, in part, on the timing of maternal infection.